WN Update - World Public Health Nutrition Association

World Nutrition Volume 5, Number 9, September 2014

WN Update World Nutrition Volume 5, Number 9, September 2014 Journal of the World Public Health Nutrition Association Published monthly at www.wphna.org/worldnutrition/

Development. The Oxford conference Protecting and creating good food systems

Oxford conference organisers (above) Barrie Margetts, Philip James, Simon Capewell, Sarah Kehoe, Sabrina Ionata. Some of the many presenters (middle row), Boyd Swinburn, Klim McPherson, Sharon Friel, Corinna Hawkes, David Stuckler. Non-government and UN agency leaders (below) Susanne Løgstrup, with Francesco Branca of WHO, and then Prakash Sherry formerly of FAO.

The Update team reports: Here above are some of the organisers of and speakers at the World Public Health Nutrition Association conference on ‘Building Healthy Global Food Systems’, held this month on 8-9 September at Keble College, Oxford. The meeting is being held just two months before the UN International Conference on Nutrition. Its conclusions will

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feed into the ICN deliberations, conclusions and final declaration. These will be designed to be endorsed and actioned by UN member states and so set agriculture, food and health policy and programme agenda for the foreseeable future. Given present circumstances of linked food, fuel and finance crises, and the looming threat of climate change, the task could not be more important.

What can be done In introducing the Oxford conference, Association President Barrie Margetts, chair of the programme organising committee, whose members also have included Association members Philip James, Simon Capewell, Sarah Kehoe, Sabrina Ionata and Fabio Gomes, says: Our vision is to review the status of diet-related ill-health, to determine the impact that existing global food systems have on health, and then explore policies that could effectively promote health and well-being and support global food systems which are environmentally, culturally and socially sustainable.

To achieve this vision the objectives of the conference are to:     

Characterise, discuss and agree what is meant by healthy diets and food systems. Identify the major global drivers that shape current global food systems. Explore how to put health and well-being first of the drivers for global food systems. Address this major global challenge by refocusing our approach to public health. Review initial political and policy successes, and examine options for a healthier future.

Barrie Margetts explains that in hosting this conference the Association has two main aims. These are to  Move the agenda forward from our Rio2012 World Nutrition Congress.  Assert our responsibilities in global public health nutrition and play a key role in building the foundations for healthy populations. He continues: We believe that healthy food systems are fundamental to global health and well being. Given the complexities that shape our food supply systems, it is clear that individuals and even countries are not able to resist and control many of the harmful forces that currently support and promote unhealthy diets. It will only be by concerted, collective, global public action that we can positively shape future food systems so they are driven by what is best for the health and well-being of the planet and its people.

WN will be reporting on the conference and its findings in future issues, leading up to the UN International Conference on Nutrition. The Update team. Development. The Oxford conference. Protecting and creating good food systems. [Update]. World Nutrition September 2014, 5, 9, 713-714


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Gaining traction

The Food System /NOVA

Access December 2012 TFS position paper #2 here Access Februaryt 2014 TFS reformulation position paper #2 here Access April 2014 news of Brazilian food guide here Access June 2016 Update on Carlos Monteiro at EAT Forum

The tremendous twelve at the University of São Paulo, plus leader Carlos Monteiro in the spotlight. Many other Food System colleagues including some based outside Brazil, are not in the picture

Jean-Claude Moubarac reports: I write as a member of the WN family and of the Food System team. Above I am the one looking serious on the right. WN editorial colleague Thiago Hérick de Sá is in the pink. Carlos Monteiro is in the spotlight at the top of the picture. This shows half the team now working on the general theory now known as The Food System,. The picture was taken in August at the University of São Paulo after a planning meeting. There are two reasons to show it now. One is that the Food System thesis with its emphasis on ultra-processing has been largely pioneered in WN and is the greatest single success of our journal. Two is that this is cause for celebrating, because the concept of ultra-processing now has traction, in many journal papers and conference presentations. More importantly, it is rapidly gaining ground in the world outside and is now being adopted in national and international policy-making designed to protect and preserve healthy food systems and thus give the best chance of population good health and well-being


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A key stage in consultation during the development of the Brazilian food guide, with colleagues from throughout Brazil, the federal Ministry of Health, and the Pan American Health Organization Latest news is that the fifth edition of the report Facts for Life being prepared for UNICEF, now out for consultation, recommends the Food System-NOVA thesis and classification for use world-wide. We at WN and in São Paulo are very happy. It says:

Box 1 The rules and guides for world health Taken from the draft of UNICEF Facts for Life now out for consultation Three golden rules to follow (recently developed for Brazil, but applicable everywhere): o Make foods and freshly prepared dishes and meals the basis of your diet o Be sure oils, fats, sugar and salt are used in moderation o Limit the intake of ready-to-consume products and avoid those that are ultra-processed.] Most countries produce healthy dietary guidelines. The following list, taken from those recently developed for Brazil provide helpful and easy to follow guidance: o Prepare meals from staple and fresh foods. o Use oils, fats, sugar and salt in moderation. o Limit consumption of ready-to-consume food and drink products. o Eat regular meals and pay attention to what you’re eating. o Don’t snack and don’t multitask while eating. o Eat in appropriate environments. Avoid all-you-can-eat settings. o Eat in company whenever possible. o Buy food at places that offer varieties of fresh foods. o Avoid those that mainly sell products ready for consumption. o Always give preference to locally produced and seasonal produce. o Develop, practice, share and enjoy your skills in food preparation and cooking. o Plan ahead to give meal preparation and eating their proper time and space. o Be critical of the commercial advertisement of food products. o Choose restaurants that serve freshly made dishes and meals. Avoid fast food chains.

Moubarac J-C. The Food System-NOVA. Gaining traction [Update]. World Nutrition September 2014, 5, 9, 715-716 Update. World Nutrition September 2014, 5, 9, 713-733

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Big Food Watch. Conferences Straight thinking Access October 2013 BFW Fabio Gomes on nutrition conferences here Access June 2014 Diana Parra on Coca-Cola and conferences here Access June 2014 The Lancet Thiago de Sá on Big Food and conferences here Access June 2014 The Lancet editorial on Big Food and conferences here Access July-August Thiago de Sá on Big Food and conferences here

Straight Thinking convenors are Thiago Hérick de Sá, Diana Parra (above left), supported by Fabio Gomes (BFW convenor). Straight Thinking advisors include Inês Rugani, Enrique Jacoby, Ricardo Uauy, and (below) David Sanders, Alejandro Calvillo, Michael Pollan, Marion Nestle, Yoni Freedhoff, supported by the WN team including assistant editor Isabela Sattamini nnn

Fabio Gomes writes: WN has sustained Big Food Watch for a year now. The WN editorial team has agreed to continue and develop BFW. The BFW network members, of which I am convenor, have now agreed a new initiative. This is to compile a manual that will show conference organisers how they can create successful scientific meetings without feeling obliged to accept support from conflicted sources. World Nutrition will publish the progress and the results of this vital initiative. It has been inspired by The Lancet and by the vision and courage of two young leaders in the public health profession, Thiago Hérick de Sá of the University of São Paulo, Brazil, and Diana Parra of Washington University, St Louis, Missouri, US.

Diana Parra and Thiago Hérick de Sá report: That’s us in the upper row above, on the left. We in the Big Food Watch network are well aware of what is wrong in our world – and the world as a whole. But how can we work together for a better world? Being negative can be easy. Thus, there is constant complaint about the penetration by Big Food transnational corporations of scientific conferences concerned with nutrition, physical activity and public health. Now is the time to be positive.


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Box 1 Straight Thinking The task of the convenors and steering group of the Big Food Watch Straight Thinking initiative, and our advisors shown above, is to compile a manual for conference organisers, showing that their meetings can be successful without any support from sources whose interests do or may conflict with those of public health. Some organisers will continue to prefer to work with the private sector. We will show that this is not necessary. The manual will cite good practice, with testimony from organisers, speakers and participants.

In response to a letter Thiago published in The Lancet, a supporting editorial stated: ‘This partnering is disgraceful. Health and medical conferences must raise their ethical standards and avoid such financial links’. So here is news of a new Big Food Watch initiative. It will enable conference organisers to choose how to raise funds and support. Some conference organisers will continue to want to work with ‘the private sector’. To them we say that transparency is essential. But many organisers want their conferences to be successful without financial or other support from sources whose interests are or could be seen as in conflict with those of public health. Here is the good news. This has been done and can be done. Big Food Watch convenor Fabio Gomes, next to us above, has agreed to include our initiative within BFW project, with the name Straight Thinking. We will work closely with Inês Rugani, next to Fabio. Inês masterminded the World Nutrition Rio2012 conference, with 1,000 participants, and a substantial financial surplus, funded solely from public sources. So we know it can be done. We also know that international conferences can succeed at many different levels of income and expenditure, from the recent spectacular EAT Forum, to assemblies of social movements. We are supported in this by The Lancet. Our initial advisors shown above collectively have immense experience of organising, presenting and participating in international conferences. More will join us. In the upper row next to Inês is Enrique Jacoby of the Pan American Health Organization, and then Ricardo Uauy, former president of the International Union of Nutritional Sciences, former director of the Chilean National Institute of Nutrition, and professor at the London School of Hygiene and Tropical Medicine. First in the lower row is David Sanders of the University of the Western Cape, who organised the recent People’s Health Movement assembly in South Africa. Next is Alejandro Calvillo, founder director of the Mexican public interest organisation El Poder del Consumidor. Next is the journalist and author Michael Pollan, then Marion Nestle of New York University and the Food Politics blog, and Yoni Freedhoff of Ottawa University, who is also a practicing physician. From World Nutrition, editor Geoffrey Cannon (not pictured), Big Food Watch convenor Fabio Gomes, and assistant editor Isabela Sattamini (lower row, right) have agreed to stimulate and publish our work. Parra DC, de Sá T. Conferences. Straight thinking [Big Food Watch] [Update]. World Nutrition September 2014, 5, 9, 717-718 Update. World Nutrition September 2014, 5, 9, 713-733

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Food, nutrition, gastronomy, health, well-being The Pollanation of Brazil Access April 2013 WN cover with Michael Pollan here Access April 2013 appraisal (1 of 2) of Michael Pollan here Access April 2013 extract from Michael Pollan’s book Cooked here Access May 2013 appraisal (2 of 2) of Michael Pollan here Access June 2013 Michael Pollan on gut microbiota here

Suppertime in Parati. Carlos Monteiro, Michael Pollan in mutual admiration, after Michael had nourished Brazilian participants with his book Cooked at the international FLIP literary festival

Geoffrey Cannon reports: Brazil is now Pollanated. Michael Pollan and his wife the painter Judith Belzer came to Brazil in late July and early August for their first time. The occasion was the launch in Brazil of Michael’s book Cooked: a Natural History of Transformation. WN celebrated Michael, and his history, writing, admirers and achievement, last year – see the links above. He was a star turn at the annual Brazilian FLIP festival of literature, founded by Liz Calder, the English living legend publisher with long and loving links with Brazil, held in Parati on the coast of Rio de Janeiro state. Brazil has been hungry for Michael, as he told me he felt too, when he and I met to eat and commune in São Paulo. His vision as expressed in his writing and in his life and testimony, combines keenly researched and exactly written understanding of nature, food systems, the meaning of dietary patterns as expressions of family and community, and also the sheer love of simple meals and great feasts as human achievements. And now Brazil is waking up to its own unique food culture, which combines native, European, African and world tradition, which altogether are a definition of Brazil. A friend here said to me ‘Michael is telling us what we need to know about us as a nation’.


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Lunchtime in São Paulo. Some of the Food System team with some star Brazilian writers and presenters and Alberto Landgraf the chef, all together with Michael Pollan and Judith Belzer In his FLIP presentation, and in his many interviews with the Brazilian media, Michael emphasised his admiration for the new national Brazilian food guide, now in the final stages of revision. As he explained: We have to focus more on food and the social context that surrounds the act of eating. The new guidelines for nutrition in Brazil are revolutionary .Instead of just saying to eat this and not that, they say for people to eat with other people, to eat real food, and to avoid ultra-processed products. Brazil is the first country to do something so progressive, related to the social and other contexts of food and not just the chemistry of what we eat.

The team at the University of São Paulo (USP) convened by Carlos Monteiro, responsible to the Brazilian federal Ministry of Health to advise on the new guide, arranged a lunch with Michael and Judith at Epice, the restaurant created by chef Alberto Landgraf. Our meal was an exquisite mix of tastes, including the native pupunha, tucupi, carne seca, mandioca, açaí and rapadura. In the picture above, USP team members Renata Bertazzi Levy, Larissa Baraldi, Maria Laura Louzada (just arrived back from working with Dariush Mozaffarian at the Harvard School of Public Health), Jean-Claude Moubarac, Francine Lima, Carla Martins and Maluh Barciotte, with Carlos Monteiro, enjoyed lunch with Michael and Judith, together with journalists and presenters Tatiana Cardoso, Juliana Dias (editor of the marvellous Malagueta blog), and the chef and television presenter Rita Lobo. The picture includes creator of our feast Alberto, whose meals embody what Michael stands for. Here attached is an interview in English with Michael by Francine Lima. Cannon G. Food, nutrition, gastronomy, health, well-being. The Pollanation of Brazil [Update]. World Nutrition September 2014, 5, 9, 719-720


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Sick societies. Obesity Can childhood obesity be controlled?

World Health Organization Commission for Ending Childhood Obesity. Above, Peter Gluckman and Sania Nishtar (the co-chairs), and then come George Alleyne, David Nabarro, Helen Clark, Sachita Shrestha, and Jacques Rogge; and then below, Constance Chan Hon Yee, Hoda Rashad, Betty King, Colin Tukuitonga, Adrian Gore, Nana Oye Lithur, Srinath Reddy, Paula Radcliffe

Our health team reports: The Commission for Ending Childhood Obesity (ECHO for short), set up at the WHO World Health Assembly in late May, held its first meeting on 17-18 July. The brief of the commission includes assessment of the social and economic as well as the health impact of childhood obesity. Announcing the commission, WHO director-general Margaret Chan stated: Social scientists, public health specialists, clinical scientists and economists will join together to synthesize the best available evidence into a coherent plan. Actors responsible for food production, manufacturing, marketing and retail; maternal health and nutrition; child health, education and health literacy; physical activity; and public policy will also be engaged in the task

We have received an internal report of the first meeting of the commission. Its findings, designed to take account of the best science and also to galvanise all relevant actors into action, are due to be completed in October 2015, for submission to the WHO Executive Board in January 2016. The commission is being guided in its work by working groups on science and evidence, and on implementation, monitoring and accountability, known in WHO as WGSE and WGIMA. First the good news. The commission is chaired by Peter Gluckman (upper row left, above) He is currently chief scientific advisor to the New Zealand government. He is Update. World Nutrition September 2014, 5, 9, 713-733

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a world authority on the pre-conceptual and early life origins of health and disease. As such he understands the cultural and social as well as the biological forces. As a scholar of deep learning he is well aware of the cardinal principle of social medicine, which is the epidemic diseases are symptoms of sick societies. Already showered with honours and recognition, he is not likely to accept standard work leading to a compromise report that gathers dust on bureaucratic shelves. He is also irascible, an admirable quality in a senior UN advisor with a position from which he is most unlikely to be dislodged. More good news is that the commission members, selected by WHO director-general Margaret Chan, are overall an imaginative group. Great skill has been used to achieve gender, age, geographic and knowledge balance. George Alleyne and David Nabarro (upper row, third and fourth from left) are grizzled heavyweights who have been working at very high level within the UN system for a generation or more. Srinath Reddy (lower row, second from right), is now the most influential public health leader in India. Helen Clark and Betty King (upper row, fifth from left, lower row third from left) have held very senior political positions outside and inside the UN system. Two interesting choices are the dynamic South African entrepreneur Adrian Gore, now the boss of ex-WHO then Pepsi-Co executive Derek Yach (lower row, fifth from, left) and Jacques Rogge, until last year president of the International Olympic Committee (upper row, right). Adrian Gore did not attend the July meeting. Biographies of all the commission members are available here. The decision to invite young people on to the commission is in principle excellent, and the biographies of Sachita Schrestha from Nepal (upper row, second from right) and Constance Chan Hon Yee from China, director of health in Hong Kong, are exciting. Marathon champion Paula Radcliffe (lower row, right) did not attend the July meeting. So this is some good news. So is the basic fact that a special commission is now set up to address the currently uncontrolled pandemic of childhood obesity, with its links to the now devastating epidemics of diabetes, adult obesity, and all the disorders and diseases associated with obesity. Also, the commission is advised by two panels including some of the most learned and wisest scholars in the world (including some contributors to WN). However, at its first meeting the commission was not happy. The brief to the commission from WHO rightly indicates behavioural and nutritional determinants: Overweight and obesity are critical indicators of the environment in which children are conceived, born, and raised. Childhood obesity is driven by biological, behavioural, and contextual factors. Biological drivers include maternal malnutrition (including both under- and over-nutrition) during pregnancy, and gestational diabetes. Inappropriate infant feeding behaviours include inadequate periods of exclusive breastfeeding and inappropriate complementary foods, as taste, appetite and food preferences are established in early life.


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Box 1 WHO Commission on ending childhood obesity Working group on science and evidence (WGSE) Professor Linda S. Adair, Dr Narendra Kumar Arora, Professor Fereidoun Azizi Professor Louise Baur, Professor Zulfiqar A. Bhutta, Dr Frank J. Chaloupka Professor Sir Partha Dasgupta, Dr Anniza de Villiers, Professor Terrence Forrester Professor Amandine Garde, Professor Mark Hanson. Professor Gerard Hastings Professor Shiriki Kumanyika., Professor Ronald Ching-Wan Ma Professor Carlos A. Monteiro, Professor John Reilly, Dr Rachel Rodin Professor Mark Tremblay, Professor Wenjuan Wang, Professor Chittaranjan Yajnik

And also points to economic, commercial and political factors: Physical activity behaviours are also established in early childhood. Contextual and wider societal factors include socioeconomic considerations, nutritional literacy within families, availability and affordability of healthy foods, inappropriate marketing of foods and nonalcoholic beverages to children and families, lack of education and reduced opportunity for physical activity…in an increasingly urbanized and digital world.

But the briefing paper from the WGSE sent to the commission apparently took a narrow view of relevant evidence. This is highly surprising, given the profiles and reputations of many of the working group members, listed above. But the WGSE representatives at the July ECHO meeting were told to go away and think again: The Commissioners commented that the report was heavily focussed on biological risk factors in early life and could be further strengthened by:       

More consideration of the social and cultural context More content on equity and the rights of the child Proposing suggested terminology and definitions of childhood obesity More emphasis on the link between childhood obesity and NCDs A scoping exercise on existing public policy More data from…interventions, even if not from low and middle income settings Suggested prioritisation of interventions and multi component interventions

The Commissioners made suggestions as to the strengthening of sections of the report of the first meeting of the WGSE… In addition, it was suggested that a number of additional working papers should be commissioned from the WGSE and also recognised that additional work may need to be commissioned … from experts outside the WGSE

We will report further in Update. We give every good wish to Peter Glickman, his cochair Sania Nishtar, the ECHO commissioners, the WGSE and WGIMA experts, and others engaged at a critical time in the history of the World Health Organization, and in the epoch of sick societies in which we and our children live now. Health team. Sick societies. Can childhood obesity be controlled? [Update]. World Nutrition September 2014, 5, 9, 721-723 Update. World Nutrition September 2014, 5, 9, 713-733

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Hot stuff Fat innocent, sugar guilty? Access December 2012 position paper Monteiro et al onThe Food System here Access March-July 2014 Ann Int Med review and debate on fat and heart disease here Access 17 March 2014 New York Times on fat and heart disease here Access August 2014 The Lancet Dariush Mozaffarian on dietary guidelines here

Time magazine covers. 1961: Ancel Keys, mastermind of the saturated fat and cholesterol hypothesis. 1984: Old fashioned bacon and egg breakfasts as killers. 1996: The invention of chemical versions of fat with no calories that cause ‘loose stools’. 2014: After over half a century fat is vindicated. Or is it? Editor’s note Here is why this Update is identified as Hot Stuff. WN occasionally publishes contributions on theses or topics that are currently the subject of intense and even furious debate. This Update is an example. It is a matter of judgement as to when debate is heated enough to be identified as Hot Stuff, and WN warmly welcomes responses for our Feedback section

The Update team reports: Time became the most influential news feature weekly in the world soon after its foundation in 1923. Its owner Henry Luce, editor-in-chief until 1964, said in his day to be the most powerful private citizen in the US, aimed to use Time to shape US opinion and make it dominant in the world. Inasmuch as any media magnate could ever do, he succeeded. The decision to feature Ancel Keys on the cover of Time in 1961 (left, above), set the agenda on the dietary causes and prevention of coronary heart disease.

Is fat innocent? As far as we know, Ancel Keys is the one and only nutrition scientist to be a Time cover star, in 1961, and the two covers next to his, from 1984 and 1996, reflect the thesis that he first made dominant and which has remained the consensus position of nutrition science ever since. This is that saturated fat and cholesterol, from any dietary source, are the most important nutritional causes of coronary heart disease. Update. World Nutrition September 2014, 5, 9, 713-733

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But now the agenda-setting Time has changed sides. The headline of its cover on the right is ‘Eat Butter’ followed by ‘Scientists labeled fat the enemy. Why they were wrong’. The feature is summarised here (1). Time does not have the weight it once had. But its cover, and its feature drawing heavily on an energetically publicised paper published early this year (2-3) has had a big impact. The paper itself has been disputed in a series of responses, whose many authors include Jim Mann, Daan Kromhout, Irwin Rosenberg, Martijn Katan, and Stewart Truswell. Walter Willett and Frank Sachs of the Harvard School of Public Health have been particularly cutting, and conclude: The conclusions of Chowdhury et al. regarding the type of fat being unimportant are seriously misleading and should be disregarded.

Is sugar guilty? The idea that saturated fat is innocuous remains very much a minority view. It is held mostly by those who defend it as contained in animal foods such as meat, milk, butter, cheese and eggs (while overlooking its presence in ultra-processed products) (4); by trans-fat ‘absolutists’ who point out that this toxic substance was unknown or overlooked until recently; and by other ‘absolutists’ who claim that refined carbohydrates, or sugars, are at the root of all nutritional evil. Certainly, the mood concerning sugar – or to be meaningful, sugars and syrups as contained in ultra-processed products, consumed in quantities that are typical in industrialised countries and settings – has changed dramatically this year, as WN readers will know. It is now commonly accepted that sugar is more or less as problematic as saturated fat, which is a big shift in opinion. But some people are now going much further. The case against sugar is made with varying degrees of vehemence by a number of writers and researchers. They mostly are referring to sugars and syrups in ultraprocessed products, often with a stress on sugared cola and other soft drink products (4). They claim that in ‘free’ form it is a direct cause of heart disease; that just as much as alcohol it is a cause of liver disease; and more broadly that it is the main nutritional cause of the multi-organ metabolic syndrome. They commonly make two indictments not made of fats (other than trans-fats) or any other dietary component (other than some chemical additives). They claim that sugar is toxic, or addictive, or both. Robert Lustig, an endocrinologist at the University of California at San Francisco, who treats and cares for obese children, is now well known as the most virulent opponent of sugar who has scientific credibility. As said in the UK daily The Guardian in late August, introducing an interview with him (5): ‘If you have any interest at all in diet, obesity, public health, diabetes, epidemiology, your own health or that of other people, you will probably be aware that sugar, not fat, is now considered the devil's food’. Sugar has constantly been attacked by lay writers and bloggers, But Robert Lustig has


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maintained his academic status, and publishes regularly in scientific journals. He also rides the media tiger. His 2009 90 minute diatribe against sugar is about to pass 5 million viewers, and he has a scorching style and way with words (5): Politicians have to come in and reset the playing field, as they have with any substance that is toxic and abused, ubiquitous and with negative consequence for society… Alcohol, cigarettes, cocaine. We don't have to ban any of them. We don't have to ban sugar. But the food industry cannot be given carte blanche. They're allowed to make money, but they're not allowed to make money by making people sick.

So what next? Robert Lustig continues to gain followers and traction. An alternative approach is proposed by Dariush Mozaffarian, one of the authors of the much-attacked paper seen as exonerating fat (3). In a recent commentary in The Lancet (6) he proposes: Now is the time to redesign our process of setting dietary guidelines. We need to move away from unhelpful classifications and policies based on crude groupings of merely chemically related nutrients (eg, total saturated fat)…which, in addition to scientific dubiousness, create confusion for consumers and opportunities for manipulation by industry – and towards food-based guidelines.

And, some would say, go further still, and focus on the impact of industrial food processing and human health (4). The scene is shifting. It is not yet clear what will remain on the stage. To be continued…

References 1 2 3

4

5 6

Chamberlain S. It’s time to end the war. New science confirms saturated fats are not to blame. Access pdf here O’Connor A. Study questions saturated fat and heart disease link. New York Times, 17 March 2014. Access pdf here Chowdhury R, Warnakula S, Kunitsor S, Crowe F, Ward H, Johnson L, Franco O, Butterworth A, Forouhi N, Thompson S, Khaw K-T, Mozaffarian D, Danesh J, Di Angelantonio E. Association of dietary, circulating, and supplement fatty acids with coronary risk: A systematic review and meta-analysis. Annals of Internal Medicine 2014; 160 (6):398-406. Access pdf of summary of paper and of responses here Monteiro CA, Cannon G, Levy RB, Claro RM, Moubarac J-C . The Food System. Ultraprocessing. The big issue for disease, good health, well-being. [Position paper] World Nutrition, December 2012, 3, 12, 527-569. Access pdf here Williams Z. Robert Lustig. The man who believes sugar is poison. The Guardian, 24 August 2014. Access pdf here Mozaffarian D. Saturated fatty acids and type 2 diabetes: more evidence to re-invent dietary guidelines. The Lancet Diabetes & Endocrinology, 6 August 2014. Access pdf here.

The Update team. Fat innocent, sugar guilty?[Hot stuff] [Update]. World Nutrition September 2014, 5, 9, 724-726 Update. World Nutrition September 2014, 5, 9, 713-733

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WN Blog Watch Yoni Freedhoff www.weightymatters.ca Access The Issue introducing Blog Watch here Access Weighty Matters by Yoni Freedhoff here

Editor’s note Beginning in this issue we review blogs and websites that are informative, provocative, trustworthy, and worth following regularly. Our first choice is Weighty Matters (access it above), produced by Yoni Freedhoff, a Canadian physician specialising in obesity with an academic position at the University of Ottawa. He is also an advisor to the UK-based Action on Sugar. See The Issue (access it above) for more details.

The Blog Watcher writes:

Visitors to Yoni Freedhoff’s site, which includes substantial blogs with high-quality responses, tweets up to 10-15 a day, and filming of himself stating pithy opinions, can expect entertainment. The fun comes from his style, which he says is cynical but is more like ironic and satirical. It also comes from items he reproduces, as above. He also points out and links to current papers in scientific and other journals that he thinks readers will value, which alone is a good reason to consult his site. Yoni Freedhoff is an attractive, enterprising Canadian physician specialising in obesity and ways of life. He has a busy practice and also an academic appointment, and is a regular speaker and journalist. His site, which is mostly about food and nutrition, raises his profile and is an advertisement for his work and his views.


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However, as he correctly states, his investigations are conscientious, and as illustrated by another recent humorous illustration he reproduces above, he is also open-minded. Thus, practically all high-profile ‘diet doctors’ in North America have written a popular book which they promote. But his The Diet Fix. Why Diets Fail, and How to Make Yours Work strongly doubts the value and utility of all conventional dieting regimes, and he does not promise that he can make readers into ‘a new you’. Many of the items on Weighty Matters raise issues and invite readers to decide what they think. Unusually for websites produced in North America Weighty Matters, while mainly aimed at Yoni Freedhoff’s core readers and market, also covers international – and transnational – issues. For instance, a recent item is about ultra-processed product marketing that invokes religion. This is illustrated by an advertisement (below), designed to promote consumption of Coca-Cola in Indonesia during the Muslim festival of Ramadan, the month of daytime fasting and prayer, this year almost all in July.

‘Of course’, he says, ‘we're all familiar with Coca-Cola's conscription of Christmas. Here's Coca-Cola's description of their Ramadan-centric campaign in Indonesia. “Coca-Cola Indonesia is holding a series of unique activations to inspire a reconnection. The program is named Sampaikan dengan Coca-Cola which means ‘Say it with Coca-Cola’. During the month of Ramadan, 1 and 1.5-liter Coca-Cola plastic bottles will feature a special design that includes the names of loved ones like Ayah (father), Ibu (mother), and Sahabat (best friend). The special packaging is intended to encourage family, colleagues, friends and companions to reconnect. The holy month


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of Ramadan is about reconnecting and forgiving each other. Yet over time, it often becomes a routine and loses the real meaning. This year, through a bottle of CocaCola, we want to bring positive inspiration to people says Esther Tanudjaja, Senior Integrated Marketing Content and Connection Manager, Coca-Cola Indonesia”.’ Many of his blogs are serious and substantial, and include a very useful ‘You might also like’ footnote item, linking to previous blogs on the same topic. Thus a recent blog on so-called ‘no carb’ regimes, links to a 2012 item. This is a fierce appraisal of Gary Taubes, on the occasion of the public launch of the Nutrition Science Initiative (NuSI), designed by Gary Taubes and colleagues ‘ to do targeted, cutting-edge experiments that will directly address the key questions of obesity and health. We then communicate the results to all audiences. Everyone deserves the truth’. This stimulates Yoni Freedhoff’s sarcastic style. He ends by saying: ‘Why we're eating more is the question that needs to be answered. While the increased consumption of highly refined carbohydrates may indeed be a player… the game that's being played isn't one-on-one. There's no doubt it's not as simple as, “eat less, move more”, and there's equally no doubt it's not as simple as just cut carbs. If either were true, everyone who wanted to be would already be skinny’. ‘So huge props [all due respect] to Mr Taubes for being such a passionate man and for truly wanting to see his theories proven... But ultimately, whereas Mr. Taubes now wants to trade in his pen for a bench and conduct research that presumably he himself won't instantaneously and churlishly deride as being useless, when it comes to clinical utility and weight management, the last thing the world needs is to believe that there's only one right way to go’. True, the sceptical reader of Weighty Matters can see this as a reason to buy and follow the advice in The Diet Fix. On some topics though, Yoni Freedhoff tells stories straight, without irony. Thus as a physician, father and citizen, he has strong feelings against the advertising and marketing of ultra-processed products to children. His attacks on Coca-Cola’s claims that Coke is never promoted to children are rightly savage. In a YouTube 13 minute video, he shows the presentation he would have made at the invitation of an industry breakfast meeting organised by the Ontario Medical Association, before being ‘disinvited’ three days before the event by PR company Fleischmann-Hillard’s vicepresident Ron Reaman, after patients were cancelled, and flights and hotel booked. Instead though: ‘My blog is read by policy makers, public health authorities, chief medical officers, professors, physicians/dietitians and other allied health professionals, journalists and nutrition bloggers the world over - folks that wouldn't have been attending that small, intimate, food industry sponsored breakfast… Uninviting me will enable me to communicate my message far further than I ever would have done otherwise.’ He starts with Froot Loops. Please access the video. Blog Watch. Yoni Freedhoff. www.weightymatters.ca. [Update]. World Nutrition September 2014, 5, 9, 727-729


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WN

From strength to strength

Here are the twelve new members of the WN family. Above are Brooke Aksnes, Ashok Bhurtyal, Colin Butler, Anthony Fardet, Sara Garduño-Diaz, and Enrique Jacoby. Below are Tim Lang, Claus Leitzmann, Diana Parra, Marcela Reyes, Stefanie Vandevijvere, and Olivia Yambi To me, WN is an incredibly important publication. Being able to find news on politics, science, research and industry in the same place simplifies the process that nutrition professionals and enthusiasts must undertake in order to be well-versed in current nutrition-related news. As a credible and valuable source of knowledge, the journal is also an essential resource to foster a network of professional and intellectual exchanges.

Our twelve new members So wrote the US national Brooke Aksnes (upper row, left, above), in response to our invitation to WN readers to apply to become assistant editors. Now at the school of public health at the Free University of Brussels, Belgium, Brooke is Summa cum laude from Long Island University, has worked in Mexico, and is fluent in Spanish and French. Our first test for applicants is to ask them to write a letter for publication in Feedback, under pressure. Hers is published this month on page 801. Next to Brooke is Ashok Bhurtyal from Nepal. He has worked for the UN, government, and public interest organisations. Ashok’s WN commentary on the state of nutrition and public health in his country is in preparation. He writes: In 2006, I worked in the Nepalese Ministry of Health and Population. In 2007, together with friends and teachers, I founded a People's Health Initiative. We attempted to launch alternative approaches to health by addressing people's concerns. Later, I joined the ministry staff for a year. In mid-2010, I joined the World Health Organization (country office, Nepal) as a professional officer assigned to work on nutrition. My work involves technical assistance to government and civil society.


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We have also invited senior scientists to strengthen us within the WN family. Next to Ashok is the big picture thinker, Colin Butler from the University of Canberra, author of a recent WN commentary and letter on impact of climate change on food supplies and global health, who at the time of writing is closeted in an invitation-only WHO meeting on climate change. Next is Anthony Fardet, whose letter on holistic nutrition this month is in Feedback on page 792. He is a senior scientist working at France’s national institute for agronomic research in Clermont-Ferrand. He writes: The science and practice of agronomy is inherently holistic, and also is shaped by public policies often enacted without population or planetary health and well-being in mind. It is reassuring to find a journal with contributions that take an integrated, holistic approach to food systems, dietary patterns, health and well-being.

Next is Sara Garduño-Diaz, a Mexican national with experience in England, now at the American University of the Middle East in Kuwait, who joins as an assistant editor. Her letter on agriculture in arid climates, complementing that by Brooke Aksnes, is in Feedback on page 797. Next is the WN Farming convenor Enrique Jacoby of the PanAmerican Health Organization. As this note was written, he was co-chairing a meeting on Latin American agriculture and food policy in Quito, Ecuador. His commentary on family farming as a lead policy in the Americas, was published in WN in June. We warmly welcome two more distinguished scientists. Tim Lang from City University, London, may be the first ever professor of food policy. Co-author of the book with that title, he is a leading champion of agriculture as determining food supplies and thus dietary patterns and also the quality of national and local culture and ways of life. Next is Claus Leitzmann of the University of Giessen, a former treasurer of the International Union of Nutritional Sciences and co-convenor of the New Nutrition Science project, writes our Source feature beginning on page 757. Three more assistant editors are as follows. Diana Parra, a Colombian national, coconvenor of the Straight Thinking initiative under the Big Food Watch banner. She writes this month on pages 718 and also on good food systems on page 734. Marcela Reyes, a public health physician at the National Institute of Nutrition in Santiago, Chile, who has written on Pablo Neruda in the age of the burger. Then Stefanie Vandevijvere, a Belgian national at the University of Auckland, New Zealand, who writes in Feedback on page 787 with Boyd Swinburn on the INFORMAS project. Olivia Yambi from Tanzania, co-chair of the new Carasso Foundation panel on sustainable food systems, previously UNICEF regional advisor for Eastern and Southern Africa, will strengthen our contributions concerning Africa. She writes: When I completed my first degree in biological sciences and was assigned to teach at a fisheries research and training institute I came across Human Nutrition in Tropical Africa, by Michael Latham. Upon reading this book carefully I had no doubt that I wanted to work on human nutrition rather than continue research on the biology of king fish


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Our established group of eight

Here are the eight established WN colleagues Geoffrey Cannon, Fabio Gomes, Seva Khambadkone, Jean-Claude Moubarac, Thiago de Sá, Isabela Sattamini, Claudio Schuftan, and Roberto de Vogli These twelve new public health and nutrition professionals now join to support WN Established members also in order of last name, are above as follows. WN editor and columnist, and University of São Paulo senior research fellow Geoffrey Cannon, whose contributions this month are on page 746 and 770. Then WN Big Food Watch convenor and Brazilian National Cancer Institute senior manager Fabio Gomes, who writes on pages 740 and 749. Seva Khambadkone of Johns Hopkins School of Public Health, US, summarises her return from ‘sabbatical’ on page 803. Jean-Claude Moubarac of the University of Montréal, convenor for WN of The Food System, contributes this month on page 736. Thiago Hérick de Sá of the University of São Paulo, co-convenor of Development, writes on pages 704 and 706 and on pages 718 and 734. Feedback editor Isabela Sattamini of Brazil’s National Cancer Institute, writes on page 738 and presides over 20 pages of letters, from New Zealand, France, the US, Kuwait, Belgium and Tanzania starting on page 787. Claudio Schuftan of the People’s Health Movement, who holds Chilean, US and German passports, lives in Vietnam, and writes on page 743. The economist Roberto de Vogli, advisor to WN Development, is an Italian national, at the University of California, Davis.

Our advisors

Members of the WN advisory board are, from left, Ted Greiner, Philip James, Urban Jonsson, Shiriki Kumanyika, Harriet Kuhnlein, Barrie Margetts, Carlos Monteiro, and Walter Willett The WN publishing and editorial advisory board above, are as follows. US national Ted Greiner of Hanyang University, South Korea, former leader within the UN System Standing Committee on Nutrition. UK national Philip James, former president of the World Obesity Forum, also of the London School of Hygiene and Tropical Medicine, and chair of the WHO study group responsible for the 1990 report Diet, Nutrition, and the Prevention of Chronic Diseases. Swedish national Urban Jonsson, former UNICEF chief of nutrition, whose letter on human rights this


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month begins on page 804. US national Shiriki Kumanyika of the University of Pennsylvania, deputy chair of the 2003 WHO-FAO report that followed the 1990 report above, and also a senior UN advisor. Next is Harriet Kuhnlein, founder-director of the Center for Indigenous People’s Nutrition and Environment, McGill University, Canada. Then Barrie Margetts, World Public Health Nutrition Association President, of the University of Southampton, UK, who introduces the Association’s Oxford conference this month on page 735. Then Carlos Monteiro of the University of São Paulo, Brazil, leader of The Food System project, also a senior UN advisor. Then Walter Willett of the Harvard School of Public Health, US, champion of the campaigns against trans-fats and for the Mediterranean Diet, distinguished nutritional epidemiologist. He collaborates with Geoffrey Cannon, also a member of the advisory board, this month on page 777.

Getting organised

WN departments and initiatives include (from left) The Food System (two symbols), Big Food Watch, Sugar, Climate, Farming, Development, Source, and as from now, Blog Watch. Hot Stuff There is plenty for all members of the editorial family to do. WN now has a series of departments and initiatives, symbolised above, some of which such as Big Food Watch, Farming and Development are regularly featured, and some, such as Climate and The Food System, need special care. We will also now be able to plan main contributions well ahead, and to strengthen our major commentaries. More news on all this soon.

How to respond Updates are short communications designed to add new information to WN commentaries and other contributions. They are invited from all readers. Updates can be to WN commentaries and other contributions published at any time. Usual length for main text of Updates is between 500 and 1,500 words but they can be shorter or longer. Any references should usually be limited to up to 10 but more are acceptable for longer pieces. Updates are edited for length and style, may be developed, and once edited are sent to authors for approval. Address contributions for publication to [email protected]


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